Capsule Endoscopy

What is Capsule Endoscopy?

Capsule Endoscopy lets your doctor examine the lining of the middle part of your gastrointestinal tract, which includes the three portions of the small intestine (duodenum, jejunum, ileum). Your doctor will give you a pill sized video camera for you to swallow. This camera has its own light source and takes pictures of your small intestine as it passes through. These pictures are sent to a small recording device you have to wear on your body.

Your doctor will be able to view these pictures at a later time and might be able to provide you with useful information regarding your small intestine.

Capsule endoscopy may also be called:
Small bowel capsule enteroscopy
wireless capsule endoscopy
Capsule endoscopy allows for examination of the small intestine, which cannot be easily reached by traditional methods of endoscopy.

Why is Capsule Endoscopy Done?

Capsule endoscopy helps your doctor evaluate the small intestine. This part of the bowel cannot be reached by traditional upper endoscopy or by colonoscopy. The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps, inflammatory bowel disease (Crohn’s disease), ulcers, and tumors of the small intestine.

As is the case with most new diagnostic procedures, not all insurance companies are currently reimbursing for this procedure. You may need to check with your own insurance company to ensure that this is a covered benefit.

How Should I Prepare for the Procedure?

An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately twelve hours before the examination. Your doctor will tell you when to start fasting.

Tell your doctor in advance about any medications you take including iron, aspirin, bismuth subsalicylate products and other over-the-counter medications. You might need to adjust your usual dose prior to the examination.

Discuss any allergies to medications as well as medical conditions, such as swallowing disorders and heart or lung disease.

Tell your doctor of the presence of a pacemaker or defibrillator, previous abdominal surgery, or previous history of bowel obstructions in the bowel, inflammatory bowel disease, or adhesions.

Your doctor may ask you to do a bowel prep/cleansing prior to the examination.

What Can I Expect During Capsule Endoscopy?

Your doctor will prepare you for the examination by applying a sensor device to your abdomen with adhesive sleeves (similar to tape). The pill-sized capsule endoscope is swallowed and passes naturally through your digestive tract while transmitting video images to a data recorder worn on your belt for approximately eight hours. At the end of the procedure you will return to the office and the data recorder is removed so that images of your small bowel can be put on a computer screen for physician review.

Most patients consider the test comfortable. The capsule endoscope is about the size of a large pill. After ingesting the capsule and until it is excreted you should not be near an MRI device or schedule an MRI examination.

What Happens After Capsule Endoscopy?

You will be able to drink clear liquids after two hours and eat a light meal after four hours following the capsule ingestion, unless your doctor instructs you otherwise. You will have to avoid vigorous physical activity such as running or jumping during the study. Your doctor generally can tell you the test results within the week following the procedure; however, the results of some tests might take longer.

What are the Possible Complications of Capsule Endoscopy?

Although complications can occur, they are rare when doctors who are specially trained and experienced in this procedure perform the test. There is potential for the capsule to be stuck at a narrowed spot in the digestive tract resulting in bowel obstruction. This usually relates to a stricture (narrowing) of the digestive tract from inflammation, prior surgery, or tumor. It’s important to recognize obstruction early. Signs of obstruction include unusual bloating, abdominal pain, nausea or vomiting. You should call your doctor immediately for any such concerns. Also, if you develop a fever after the test, have trouble swallowing or experience chest pain, tell your doctor immediately. Be careful not to prematurely disconnect the system as this may result in loss of pictures being sent to your recording device.

Esophageal pH Study

What is an esophageal pH test?

An esophageal pH test measures and records the pH in your esophagus to determine if you have gastroesophageal reflux disease (GERD). The test can also be done to determine the effectiveness of medications or surgical treatment for GERD.

What is esophageal reflux?

Esophageal reflux is a condition in which stomach acid refluxes or moves back into the esophagus (the “food pipe” leading from the mouth to the stomach). What happens during esophageal reflux?

A specialized muscle, called the lower esophageal sphincter, is located where the esophagus meets the stomach (see figure). This sphincter opens to allow food and liquid to pass into the stomach, then closes. When the sphincter does not close tightly, food particles, stomach acid and other digestive juices can splash back up into the esophagus. When this happens, the condition is called gastroesophageal reflux. When reflux occurs on a regular basis, it can cause permanent damage to the esophagus. The esophageal pH test measures how often stomach contents reflux into the lower esophagus and how much acid the reflux contains.

How does the Bravo esophageal pH test work?

A small capsule, about the size of a gel cap, is temporarily attached to the wall of the esophagus during an upper endoscopy. The capsule measures pH levels in the esophagus and transmits readings by radio telecommunications to a receiver (about the size of a pager) worn on your belt or waistband. The receiver has several buttons on it that you will press to record symptoms of GERD such as heartburn (the nurse will tell you what symptoms to record). You will be asked to maintain a diary to record certain events such as when you start and stop eating and drinking, when you lie down, and when you get back up. This will be explained by the nurse.

How do I prepare for the Bravo esophageal pH test?

Let your physician know if you have a pacemaker or implantable heart defibrillator, a history of bleeding problems, dilated blood vessels, and any other previously known problems with your esophagus.

You may be requested to hold or keep following medications by your gastroenterologist. The decision will be made depending the purpose the Bravo esophageal pH test.
● Seven days before the monitoring period, do not take proton pump inhibitors such as omeprazole (Prilosec® ), lansoprazole (Prevacid® , rabeprazole (Aciphex® ), pantoprazole (Protonix® ), esomeprazole (Nexium® )
● Two days (48 hours) before the monitoring period, do not take the H2 blockers ranitidine (Zantac® ), cimetidine (Tagamet® ), famotidine (Pepcid® ), nizatidine (Axid® ); or the promotility drug, metoclopramide (Reglan® )
● Six hours before the monitoring period, do not take antacids (such as Alka-Seltzer® , Gaviscon® Maalox® , Milk of Magnesia® , Mylanta® , Phillips® , Riopan® , Tums® or any other brands)
● Four to 6 hours before your appointment do not eat or drink
Please note: Occasionally, your doctor may want you to continue taking a certain medication during the monitoring period to determine if it is effective Once the test has begun, what do I need to know and do?
● Activity: Follow your usual daily routine. Do not reduce or change your activities during the monitoring period. Doing so can make the monitoring results less useful. Note: Do not get the receiver wet; it is not waterproof!
● Eating: Eat your regular meals at the usual times. If you do not eat during the monitoring period, your stomach will not produce acid as usual, and the test results will not be accurate. Eat at least 2 meals a day. Eat foods that tend to increase your symptoms (without making yourself miserable). Avoid snacking. Do not suck on hard candy or lozenges and do not chew gum during the monitoring period.
● Lying down: Remain upright throughout the day. Do not lie down until you go to bed (unless napping or lying down during the day is part of your daily routine).
● Medications: Continue to follow your doctor’s advice regarding medications to avoid during the monitoring period.
● Recording symptoms: Press the appropriate button on the receiver when symptoms occur (as discussed with the nurse). Record the time you start and stop eating and drinking (anything other than plain water). Record the time you lie down (even if just resting) and when you get back up. The nurse will explain this.
● Unusual symptoms or side effects: If you think you may be experiencing any unusual symptoms or side effects, call your doctor.

You will return the receiver and diary when the monitoring period is over. The information on the receiver and diary will be downloaded to a computer and the results will be analyzed. Preliminary study data will be reviewed with you if you desire.

After completion of the study
● Resume your normal diet and medications.
● Your doctor will discuss the results of your test with you during your next scheduled appointment.
● Normal activities — such as swallowing, eating and drinking — will cause the disposable pH capsule to detach and pass through the digestive tract in 7 to 10 days on average.
● No MRI exams (magnetic resonance imaging) should be performed for 30 days following capsule insertion.